1922236611 NPI number — DIABETIC COMFORT SHOES INC.

Table of content: ERIC RODNEY TOMPKINS MD (NPI 1902888688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922236611 NPI number — DIABETIC COMFORT SHOES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIABETIC COMFORT SHOES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MEDICAL SUPPLY AND DIABETIC SHOES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922236611
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2311 W BURBANK BLVD
Provider Second Line Business Mailing Address:
UNIT A
Provider Business Mailing Address City Name:
BURBANK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91506-1235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-859-7755
Provider Business Mailing Address Fax Number:
818-859-7005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2311 W BURBANK BLVD
Provider Second Line Business Practice Location Address:
UNIT A
Provider Business Practice Location Address City Name:
BURBANK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91506-1235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-859-7755
Provider Business Practice Location Address Fax Number:
818-859-7005
Provider Enumeration Date:
07/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
VARDUMYAN
Authorized Official First Name:
ARTHUR
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/ CERTIFIED PEDORTHIST
Authorized Official Telephone Number:
818-653-9595

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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